TB severity during COVID-19 pandemic in patients admitted in a tertiary clinic for lung diseases in Romania

COVID-19 pandemic has brought unprecedented challenges to healthcare systems worldwide, limiting the addressability of tuberculosis (TB) patients to medical care, and thus delaying the diagnostic. This retrospective observational study aims to assess the severity of TB at admission in patients admitted in our clinic during the COVID-19 pandemic, as compared to TB cases hospitalized before the pandemic. Severity at admission was assessed by microbiological analysis (high intensity of positive baseline sputum smears: 3+ or 2+ in semi-quantitative smear reading), and radiologic severity evaluated by Ralph score (0 to 140 points) and Falk score (mild, moderate, severe). The study group included 112 patients admitted between 01.07.2020 and 31.12.2020 (during the pandemic), the control group included 232 patients admitted between 01.07.2019 and 31.12.2019 (pre-pandemic). In the study group, 69% (67/96) of patients had a severe Falk score, compared to just 46% (99/215) in the control group. Median Ralph score was 70 points in study group, while in the control group was 50 points. The difference between the two groups is statistically significant for both scores. Sputum smear results showed an increased bacillary load in the study group, 3+ or 2+ in 46% (43/94) of patients, and only 35% (81/232) in the control group (p<0.01). The study demonstrates a significantly higher proportion of severe TB cases in patients admitted during the COVID-19 pandemic, due to reduced accessibility to medical care and delayed presentation. Any kind of disruptions of the public healthcare system should not hinder early detection and treatment of TB cases.